Provider Demographics
NPI:1942987953
Name:MACKENZIE, CHELSEY (CNM)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CHELSEY
Other - Middle Name:
Other - Last Name:HICKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 HOSPITAL DR STE 270
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 HOSPITAL DR STE 270
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3244
Practice Address - Country:US
Practice Address - Phone:843-818-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27557367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife